Guido Lancman, MD, on the Study Design of IVIG in Patients with Multiple Myeloma Receiving Daratumumab

December 26, 2020
Guido Lancman, MD

A study of the effect of intravenous immunoglobulin (IVIG) on infections in patients with multiple myeloma receiving daratumumab indicated that hypogammaglobulinemia was nearly universal during treatment, suggesting a role for IVIG.

A study of the effect of intravenous immunoglobulin (IVIG) on infections in patients with multiple myeloma receiving daratumumab (Darzalex) presented at the 2020 American Society of Hematology Virtual Symposium found that hypogammaglobulinemia was nearly universal during treatment with daratumumab, suggesting a role for IVIG – especially in patients with recurrent infections.

In an interview with CancerNetwork®, Guido Lancman, MD, hematology and oncology fellow at the Icahn School of Medicine at Mount Sinai, explained the design of the study and what led him and his colleagues to perform the study.

Transcription:

Sure. So, to start off, daratumumab is a CD38 monoclonal antibody. It's been shown to improve outcomes in both relapsed, refractory, and newly diagnosed myeloma. And it's overall very well tolerated. But across phase 3 studies of daratumumab there's been a consistently increased signal of infections, particularly in the respiratory tract. And since daratumumab kills not only myeloma cells, but also normal plasma cells, it can lead to decreased production of antibodies or immunoglobulins, known as hypogammaglobulinemia.

So, in our study, we actually wanted to see if replacement of immunoglobulins with IVIG, intravenous immunoglobulin, would actually decrease infection rates in patients treated with daratumumab. So, what we did is we looked at all patients at our institution who got both daratumumab and IVIG, but multiple myeloma, so it was 43 patients. And what we did was we divided their time periods into times they were getting IVIG, which was from their date of IVIG administration, until 1 month after, that's approximately how long the effect lasts for, and then the time periods there were off IVIG. And so, we compared the infection rates during those 2 time periods.

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